The Evolving Pathophysiology of Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia (BPD) is the most common morbidity in very preterm infants, and is characterized by abnormal development of the lung. The pathophysiology of BPD is primarily due to effects of placental dysfunction, hyperoxia, ventilator-induced lung injury, poor nutrition, abnormal blood flow, and genomic/epigenomic factors on an immature lung. These adverse factors act on multiple cell types through many interacting signaling pathways.

QIing your QI: a 13-year experience of a paediatric residency QI programme.

Introduction: QI education is essential for resident physicians with established requirements from the Accreditation Council for Graduate Medical Education outlining the necessary components. Literature supports the inclusion of both didactic and experiential learning, however, most studies review knowledge and attitude based assessments of residency QI programs. In 2012, our pediatric residency program identified a gap in resident engagement in QI, which led to the formalization of a QI education program grounded in the Institute for Healthcare Improvement (IHI) Model for improvement with objective measures of QI projects.

Severity of Bronchopulmonary Dysplasia in Infants Born Extremely Preterm and Randomized to Early Human Milk Fortification with a Donor Milk-Derived Fortifier for 2 Weeks.

In this secondary analysis of a masked clinical trial involving 150 infants born extremely preterm randomized to receive fortified milk starting on either postnatal day 3 (early group) or day 14 (delayed group), we found a significant difference in the distribution of bronchopulmonary dysplasia severity between the 2 groups (P = .039) with milder forms of bronchopulmonary dysplasia in the early group.

Early Vitamin D Supplementation in Infants Born Extremely Preterm and Fed Human Milk: A Randomized Controlled Trial.

Objective: To evaluate the effects of vitamin D supplementation on short-term respiratory outcomes in infants born at 28 weeks of gestation or less and fed human milk.

Study Design: This masked, randomized controlled trial included infants born extremely preterm and fed human milk in 2023-2024. Infants received either 800 IU/day vitamin D (intervention) or no additional vitamin D (control) for the first 14 days.

Reducing NICU ventilator days by preventing fluid overload with the CAN-U-P-LOTS standardized bundle.

Background: Fluid overload in critically ill neonates and infants is associated with higher ventilation days, prolonged length of stay, and mortality.

Methods: This quality improvement study enrolled infants admitted to Children's of Alabama NICU (excluding those with tracheostomies, severe congenital kidney or heart disease, DNR status, or severe genetic conditions). We compared 7 months of pre-intervention data (211 neonates) with 7 months of post-implementation data (218 neonates).

Late Permissive Hypercapnia for Mechanically Ventilated Preterm Infants: A Randomized Trial.

Objective: To determine if targeting higher levels of pH-controlled permissive hypercapnia beyond postnatal day 7-14 reduces mechanical ventilation duration in preterm infants.

Methods: Single-center randomized clinical trial with a 1:1 parallel allocation including infants from 22-36 weeks' gestation mechanically ventilated for respiratory distress syndrome on postnatal day 7-14. We targeted higher levels of pH-controlled permissive hypercapnia (60-75 mmHg and pH ≥ 7.

Diagnostic accuracy of an over-the-counter infant pulse oximeter for cardiorespiratory events.

Objective: To determine the diagnostic accuracy of an over-the-counter infant pulse oximeter for cardiorespiratory events.

Design: Single-centre prospective diagnostic accuracy study.

Setting: University of Alabama at Birmingham.

Considerations for obstetric management of births 22-25 weeks' gestation.

Preterm birth between 22 and 25 5/7 weeks complicates <1% of live births within the United States though contributes more than 20% of infant mortality within the first year of life. Ante- and intrapartum interventions such as antenatal corticosteroids, magnesium sulfate, and tocolytic and antibiotic therapies have been shown effective in optimizing postnatal prognosis in births at 24 weeks and beyond. Interventions, mode of delivery, and resuscitation plans should ideally be discussed with the perinatology, neonatology, and nursing teams with the family using shared decision making.

It's the little things. A framework and guidance for programs to care for infants 22-23 weeks' gestational age.

Neonatal intensive care units (NICUs) developing a tiny baby program-a clinical approach for care of infants born before 24 weeks' gestation-have a limited, but growing, body of evidence to guide practice. Infants born 22-23 weeks have more immature organ development and physiology than more mature extremely low birth weight infants. Centers of excellence (CoEs) in the care of tiny babies have evolved integrated approaches to clinical care in which the management of each physiologic system impacts other systems.

The Relationship Between Hispanic Ethnicity and Outcomes for Infants Born Extremely Preterm.

Objective: To characterize the association between maternal ethnicity and infant survival to discharge without major morbidity.

Study Design: This is secondary analysis of a prospective cohort of infants born <27 weeks of gestation at National Institute of Child Health and Human Development Neonatal Research Network centers from 2006 through 2020. The primary outcome was survival to discharge without major morbidity (sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia grade 3, intracranial hemorrhage grade ≥3, periventricular leukomalacia, and advanced retinopathy of prematurity).

A Tool to Help Nurses Provide Health Education on Adverse Pregnancy Outcomes and Cardiovascular Health.

Adverse pregnancy outcomes are associated with poor short- and long-term cardiovascular health. However, patients and their health care providers may not have knowledge of this risk or of the healthful practices that can reduce this risk. Childbirth care can be a pivotal time in the patient-clinician relationship to build awareness and spur prevention planning.

Cerebral injury and retinopathy as risk factors for blindness in extremely preterm infants.

Objective: This study investigates whether and to what extent cerebral injury is associated with bilateral blindness in extremely preterm infants, which has been attributed mainly to retinopathy of prematurity (ROP).

Design: Multicentre analysis of children born from 1994 to 2021 at gestational age 22 0/7 to 28 6/7 weeks with follow-up at 18-26 months. Logistic regression examined the adjusted association of bilateral blindness with severe ROP and/or cerebral injury among extremely preterm infants.

Control of breathing in preterm infants on incubator oxygen or nasal cannula oxygen.

Background: Incubator oxygen may improve respiratory stability in preterm infants compared with nasal cannula oxygen.

Methods: Single center randomized trial of infants <29 weeks' gestation on supplemental oxygen at ≥32 weeks' postmenstrual age. Infants were crossed-over every 24 hours for 96 hours between incubator oxygen and nasal cannula ≤1.

When HIPAA hurts: legal barriers to texting may reinforce healthcare disparities and disenfranchise vulnerable patients.

Effective health communication between healthcare providers and patients is a cornerstone of quality healthcare. It underpins trust, comprehension, and patient-informed care. Robust research shows that effective communication, including the use of text messaging for communication can improve maternal/fetal and neonatal outcomes and patient satisfaction, particularly among vulnerable patients.

Social Distancing During the COVID-19 Pandemic and Neonatal Mortality in the US.

Importance: Neonatal mortality is a major public health concern that was potentially impacted by the COVID-19 pandemic. To prepare for future health crises, it is important to investigate whether COVID-19 pandemic-related interventions were associated with changes in neonatal mortality.

Objective: To investigate whether social distancing during the pandemic was associated with a higher neonatal mortality rate.

Heart rate characteristics predict risk of mortality in preterm infants in low and high target oxygen saturation ranges.

Background: The Neonatal Oxygenation Prospective Meta-analysis found that in infants <28 weeks gestational age, targeting an oxygen saturation ( ) range of 85-89% 91-95% resulted in lower rates of retinopathy of prematurity but increased mortality. We aimed to evaluate the accuracy of the heart rate characteristics index (HRCi) in assessing the dynamic risk of mortality among infants managed with low and high target ranges.

Methods: We linked the SUPPORT and HRCi datasets from one centre in which the randomised controlled trials overlapped.

Achieved oxygen saturations and risk for bronchopulmonary dysplasia with pulmonary hypertension in preterm infants.

Objective: Characterisation of oxygen saturation (SpO)-related predictors that correspond with both bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) development and survival status in infants with BPD-PH may improve patient outcomes. This investigation assessed whether (1) infants with BPD-PH compared with infants with BPD alone, and (2) BPD-PH non-survivors compared with BPD-PH survivors would (a) achieve lower SpO distributions, (b) have a higher fraction of inspired oxygen (FiO) exposure and (c) have a higher oxygen saturation index (OSI).

Design: Case-control study between infants with BPD-PH (cases) and BPD alone (controls) and by survival status within cases.

Highly comparative time series analysis of oxygen saturation and heart rate to predict respiratory outcomes in extremely preterm infants.

Highly comparative time series analysis (HCTSA) is a novel approach involving massive feature extraction using publicly available code from many disciplines. The Prematurity-Related Ventilatory Control (Pre-Vent) observational multicenter prospective study collected bedside monitor data from>700extremely preterm infants to identify physiologic features that predict respiratory outcomes..

Ventilatory Assistance Before Umbilical Cord Clamping in Extremely Preterm Infants: A Randomized Clinical Trial.

Importance: Providing assisted ventilation during delayed umbilical cord clamping may improve outcomes for extremely preterm infants.

Objective: To determine whether assisted ventilation in extremely preterm infants (23 0/7 to 28 6/7 weeks' gestational age [GA]) followed by cord clamping reduces intraventricular hemorrhage (IVH) or early death.

Design, Setting, And Participants: This phase 3, 1:1, parallel-stratified randomized clinical trial conducted at 12 perinatal centers across the US and Canada from September 2, 2016, through February 21, 2023, assessed IVH and early death outcomes of extremely preterm infants randomized to receive 120 seconds of assisted ventilation followed by cord clamping vs delayed cord clamping for 30 to 60 seconds with ventilatory assistance afterward.

Apnea, Intermittent Hypoxemia, and Bradycardia Events Predict Late-Onset Sepsis in Infants Born Extremely Preterm.

Objective: The objective of this study was to examine the association of cardiorespiratory events, including apnea, periodic breathing, intermittent hypoxemia (IH), and bradycardia, with late-onset sepsis for extremely preterm infants (<29 weeks of gestational age) on vs off invasive mechanical ventilation.

Study Design: This is a retrospective analysis of data from infants enrolled in Pre-Vent (ClinicalTrials.gov identifier NCT03174301), an observational study in 5 level IV neonatal intensive care units.

Social Determinants of Health and Redirection of Care for Infants Born Extremely Preterm.

Importance: Redirection of care refers to withdrawal, withholding, or limiting escalation of treatment. Whether maternal social determinants of health are associated with redirection of care discussions merits understanding.

Objective: To examine associations between maternal social determinants of health and redirection of care discussions for infants born extremely preterm.

Extended CPAP or low-flow nasal cannula for intermittent hypoxaemia in preterm infants: a 24-hour randomised clinical trial.

Objective: Optimal timing of continuous positive airway pressure (CPAP) cessation in preterm infants remains undetermined. We hypothesised that CPAP extension compared with weaning to low-flow nasal cannula (NC) reduces intermittent hypoxaemia (IH) and respiratory instability in preterm infants meeting criteria to discontinue CPAP.

Design: Single-centre randomised clinical trial.